Healthcare Provider Details

I. General information

NPI: 1801099106
Provider Name (Legal Business Name): DR. VICTORIA CATALINA GROSSO-GODDARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA CATALINA GROSSO PH.D.

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 BROADWAY
NEW YORK NY
10027-7004
US

IV. Provider business mailing address

359 W END RD
SOUTH ORANGE NJ
07079-1445
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-2878
  • Fax:
Mailing address:
  • Phone: 973-378-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011787 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: